1013940253 NPI number — PREMIER ANESTHESIA OF RICHLAND A DIVISION OF PREMIER ANESTHESIA, LLC

Table of content: (NPI 1013940253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013940253 NPI number — PREMIER ANESTHESIA OF RICHLAND A DIVISION OF PREMIER ANESTHESIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ANESTHESIA OF RICHLAND A DIVISION OF PREMIER ANESTHESIA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013940253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2655 NORTHWINDS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009-2280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-643-5501
Provider Business Mailing Address Fax Number:
404-941-1304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 SWIFT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-643-5501
Provider Business Practice Location Address Fax Number:
404-941-1304
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUMMEL
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXCUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
770-643-5501

Provider Taxonomy Codes

  • Taxonomy code: 207LC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)